脉冲调整技术和关节松动术治疗肩峰下撞击综合征的临床疗效对比

The comparison of the effects between pulse adjust technique and mobilization in patients with subacromial impingement syndrome

目的:比较脉冲调整技术和关节松动术对肩峰下撞击综合征患者的临床疗效。方法:将38例肩峰下撞击综合征患者随机分为脉冲组(脉冲调整技术)和松动组(关节松动术)各19例。脉冲组进行脉冲调整技术治疗、常规理疗和运动训练,松动组进行关节松动术、常规理疗和运动训练。两组患者均进行12周治疗,并于治疗前和治疗第1周、第4周、第12周随访时采用VAS评分和CMS量表进行评估。结果:治疗后第1周、第4周、第12周脉冲组VAS分数分别为2.4±1.3、1.2±1.0、0.9±0.9,CMS总分分别为76.5±11.0、84.3±8.8、89.0±7.1;松动组VAS分数分别为3.5±1.3、2.1±1.3、1.4±1.2,CMS总分分别为69.4±13.1、82.9±6.7、88.5±6.8。两组VAS分数和CMS总分组内对比差异均有显著性意义(P<0.01);治疗1周后,脉冲组VAS分数低于松动组,差异有显著性意义(P=0.008),脉冲组CMS评分中的疼痛得分、ADL得分均高于松动组,差异均有显著性意义(P=0.008,P=0.009);治疗4周后,脉冲组VAS分数低于松动组,差异有显著性意义(P=0.034),CMS评分中的疼痛得分高于松动组,差异有显著性意义(P=0.048)。结论:在常规理疗和运动训练基础上无论联合应用脉冲调整技术还是关节松动术,均能有效改善肩峰下撞击综合征患者肩部的疼痛和功能障碍。而脉冲调整技术与关节松动术相比,能在治疗早期更快地减轻疼痛并改善患者日常生活活动能力。

Objective： To compare the effects between pulse adjust technique and mobilization to patients with subacromial impingement syndrome. Method： 38 cases with subacromial impingement syndrome were randomly divided into pulse group （pulse adjust technique） and mobilization group （mobilization）. The pulse group received pulse adjust technique therapy, conventional rehabilitation therapy and exercise training, while the mobilization group received mobilization, conventional rehabilitation and exercise training. The treatment for both two groups lasted for twelve weeks. All the patients were asked to complete visual analogue scale （VAS） and Constant-Murley scale （CMS） before the treatment, one week, four weeks and twelve weeks after treatment. Result： The VAS scores of pulse group were 2.4±1.3,1.2±1.0 and 0.9±0.9 for 1,4,12 weeks treatment respectively; The VAS scores of mobilization group were 3.5±1.3, 2.1±1.3 and 1.4±1.2; The CMS scores of mobilization group were 69.4±13.1,82.9±6.7 and 88.5±6.8. There were significant differences in VAS and CMS scores between before and after treatment for each group（P〈0.01）. After one week, the VAS score of pulse group was significantly lower than that of mobilization group（P=0.008）; the scores of pain and ADL subscales in CMS（P=0.008, P=0.009, respectively） were significantly higher than those in mobilization group. After four weeks, the VAS score of pulse group was significantly lower than that of mobilization group（P=0.034）; the scores of pain subscale in CMS（P=0.048） were significantly higher than those in mobilization group. Conclusion： The pain and dysfunction of the patients with subacromial impingement syndrome could be improved no matter after the pulse adjust technique and mobilization with the conventional rehabilitation and exercise training. However, pulse adjust technique could better reduce the pain and enhance the ADL function at the early phase of treatment than mobilization.